Presentation is loading. Please wait.

Presentation is loading. Please wait.

Donata Villari Sod Urologia II Azienda Ospedaliera Universitaria Careggi Firenze surgery as primary treatment in prostate cancer.

Similar presentations


Presentation on theme: "Donata Villari Sod Urologia II Azienda Ospedaliera Universitaria Careggi Firenze surgery as primary treatment in prostate cancer."— Presentation transcript:

1 Donata Villari Sod Urologia II Azienda Ospedaliera Universitaria Careggi Firenze surgery as primary treatment in prostate cancer

2 Prostatectomia radicale (PR) Terapia "gold standard” del tumore prostatico localizzato mediante rimozione in blocco di prostata e vescicole seminali Life expectancy >10 anni Età ≤75 anni (?) Stadio cT1b-T2, N0, M0 T3a, GS>8, PSA<20ng/mL Prostatectomia retropubica“open” Prostatectomia videolaparoscopica Prostatectomia robotica

3 Stadiazione clinica accurata - il paziente ideale Età e performance status Familiarità ER PSA alla diagnosi Gleason score bioptico, numero e sede dei frustoli positivi T clinico IIEF-5

4 Fig. 4 Number of men aged ≥70 years and ≥80 years in more developed countries. Men over the age of 70 years are the fasted growing segment of the population. Data from 2010 to 2050 are projections [8]. Jean-Pierre Droz, Lodovico Balducci, Michel Bolla, Mark Emberton, John M. Fitzpatrick, Steven Joniau, Michae... Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults Critical Reviews in Oncology/Hematology, Volume 73, Issue 1, 2010,

5 Fig. 6 Life expectancy in senior adults: a large variability reflecting health status variability. For a given age, a proportion of men in the top 25th percentile have a good health status and may have a longer life expectancy than men who are 5, 10 or eve... Jean-Pierre Droz, Lodovico Balducci, Michel Bolla, Mark Emberton, John M. Fitzpatrick, Steven Joniau, Michae... Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults Critical Reviews in Oncology/Hematology, Volume 73, Issue 1, 2010,

6 Fig. 7 General scheme for the treatment decision-making in senior adults with prostate cancer. Jean-Pierre Droz, Lodovico Balducci, Michel Bolla, Mark Emberton, John M. Fitzpatrick, Steven Joniau, Michae... Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults Critical Reviews in Oncology/Hematology, Volume 73, Issue 1, 2010,

7 Fig. 7 General scheme for the treatment decision-making in senior adults with prostate cancer. Jean-Pierre Droz, Lodovico Balducci, Michel Bolla, Mark Emberton, John M. Fitzpatrick, Steven Joniau, Michae... Background for the proposal of SIOG guidelines for the management of prostate cancer in senior adults Critical Reviews in Oncology/Hematology, Volume 73, Issue 1, 2010,

8

9 2014

10

11 Low risk < 25% PSA failure ≤ T2a and Gleason ≤ 6 and PSA < 10 ng/ml Intermediate risk 25-50% PSA failure T2b or Gleason 7 or PSA ng/ml High risk > 50 % PSA failure T2c or Gleason 8-10 or PSA> 20 ng/ml

12 Biochemical survival among radical prostatectomy patients with low-risk prostate cancer. Kaplan-Meier curves for biochemical recurrence-free survival among patients with low-risk prostate cancer undergoing radical prostatectomy, stratified by Cancer of the Prostate Risk Assessment (CAPRA) score. Contemporary Trends in Low Risk Prostate Cancer: Risk Assessment and Treatment J J Urol Matthew R. Cooperberg,* Jeannette M. Broering,* Philip W. Kantoff† and Peter R. Carroll‡,§ 7

13 Click to edit the outline text format Second Outline Level  Third Outline Level Fourth Outline Level  Fifth Outline Level  Sixth Outline Level  Seventh Outline Level  Eighth Outline Level Ninth Outline LevelClick to edit Master text styles – Second level Third level – Fourth level » Fifth level J Clin Oncol 2011 L’importanza delle categorie di rischio

14 GLEASON + PSA = STADIO PRESUNTO VOLUME Partin AW Combination of Prostate-specific antigen,clinical stage, and Gleason score to predict pathological stage of localized prostate cancer :a multiisituzional update JAMA 1997 La stadiazione clinica

15

16 VOLUME DELLA NEOPLASIA

17 T2 (intra) T3(extra) PENETRAZIONE CAPSULARE

18  Very promising technique  Useful in selected cases. Could suggest to perform first or repeated biopsy

19

20 2014

21 Fascio vasculo-nervoso T1 T2

22

23 “Achieving the balance between preserving the neurovascular bundles and eliminating the entire tumour continues to be a difficult task.” The more the crucial structures are spared, the higher the chance that parts of the tumour will be left behind.

24 Trifecta outcomes in radical prostatectomy series according to the literature

25 Fig. 1 Patient flow chart. CaPSURE = Cancer of the Prostate Strategic Urologic Research Endeavor; QoL = quality of life. Sanoj Punnen, Janet E. Cowan, June M. Chan, Peter R. Carroll, Matthew R. Cooperberg Long-term Health-related Quality of Life After Primary Treatment for Localized Prostate Cancer: Results from the CaPSURE Registry European Urology, 2014 Median follow up:74 mo (50-102) Quality of life

26 Sanoj Punnen, Janet E. Cowan, June M. Chan, Peter R. Carroll, Matthew R. Cooperberg Eur Urol 2014 Long-term Health-related Quality of Life After Primary Treatment for Localized Prostate Cancer: Results from the CaPSURE Registry Adjusted mean summary scores for the Medical Outcomes Studies 36-item Short Form (a) physical function and (b) mental health, and for the University of California, Los Angeles, Prostate Cancer Index (c) sexual function, (d) sexual bother, (e) urinary function, (f) urinary bother, (g) bowel function, and (h) bowel bother are displayed over time by primary treatment type among 3294 men in the study cohort. BT = brachytherapy; EBRT = external beam radiotherapy; NSRP = nerve- sparing radicalprostatectomy;NonNSRP=non nerve sparing radical prostatectomy PADT = primary androgen deprivation therapy; PRE = before treatment; WW/AS = watchful waiting/active surveillance.

27 Health domain NSRPNon-NSRPBTEBRTPADTWW/AS SF-36 Physical function 93 (14)88 (19)82 (22)78 (23)74 (24)71 (29) Mental health 79 (16)78 (16)79 (15)81 (15)80 (16)77 (19) UCLA PCI Sexual function 65 (26)54 (28)43 (30)35 (28)32 (26)32 (28) Sexual bother 71 (34)61 (37)54 (39)53 (40)55 (41)44 (41) Urinary function 93 (12)93 (13)92 (13)91 (14)90 (16)87 (22) Urinary bother 89 (19)85 (24)83 (24)81 (27)79 (28)77 (33) Bowel function 90 (12)88 (14) 87 (13)84 (17)86 (17) Bowel bother 93 (16)90 (20)88 (21)86 (23)83 (25)87 (22) Mean health-related quality of life summary scores at baseline for 3294 men in the study cohort by primary treatment modality BT = brachytherapy; EBRT = external beam radiotherapy; NSRP = nerve-sparing radical prostatectomy; PADT = primary androgen deprivation therapy WW/AS = watchful waiting/active surveillance Data are shown as mean (standard deviation ).

28

29

30

31

32

33 2014

34

35 CHIRURGIA ROBOT-ASSISTED IN ITALIA L’Italia è il secondo paese in Europa e il quarto nel mondo per numero di robot «Da Vinci» attualmente in uso: 1. U.S.A. (2000) 2. Giappone (138) 3. Francia (69) 4. Italia (64) Oltre 9000 procedure robotiche eseguite in Italia nel 2013

36 procedure a Settembre2014 Dept. Of Urology, AOUC Careggi, Florence POLO DI CHIRURGIA ROBOTICA DELLA REGIONE TOSCANA

37 Stratificazione per tipo di intervento POLO DI CHIRURGIA ROBOTICA DELLA REGIONE TOSCANA Dept. Of Urology, AOUC Careggi, Florence

38 POLO DI CHIRURGIA ROBOTICA DELLA REGIONE TOSCANA Vantaggi dell’impiego del sistema robotico monodisciplinare in struttura con alto volume operatorio Rapida acquisizione di casistica adeguata Riduzione della curva di apprendimento Formazione rapida di una equipe Miglioramento “outcomes” oncologici e funzionali e riduzione dei costi

39 RAPN POLO DI CHIRURGIA ROBOTICA DELLA REGIONE TOSCANA Dept. Of Urology, AOUC Careggi, Florence Open VS. Simple Laparoscopic VS. Robot-assisted procedures

40 Procedure Radical (non-NS) (5,6%) NS Monolateral (18.3%) NS Bilateral(76.3%) Linfoadenectomy(8,9%) Operative time (min) mean (range) 208 (70-540) Consolle time (min) mean (range) 178 (40-510) Estimated Blood Loss (cc) mean (range) 240 (50-800) Dati intraoperatori Clinica Urologica, AOUC Careggi

41 Positive surgical margins Open (1)Robot (2)P Overall9.5%16.1%<  Apex  Lateral  Posterior 4% 3.3% 2.1% 5.1% 6.4% 4.6% pT2a-b pT2c pT3a pT3b 0 5.9% 11.2% 23.4% 2.1% 13.2% 34.6% 35.7% Open (1)Robot (2)P Catheter removal (day) 14 (10-21)7 (6-12)0.003 Drainage removal (day) 5.2 (3-34)3 (2-14)0.05 Length of hospitalization (days) 6.5 (4-36)4 (2-16)0.04 Dati peri e postoperatori Clinica Urologica, AOUC Careggi

42 * Ratio drainage creatinine/serum creatinine ≥ 2 Complicanze Clinica Urologica, AOUC Careggi Perioperative complications (INTRA + POST) OPEN (1)ROBOT (2) P Conversion to open -0- Bleeding requiring transfusion 3,4%0,8%0.08 Bleeding requiring reintervention 0,6%0- Infections 5,2%4,0%0.55 Drain leakage for urine fistula * 4,6%2,7% Reintervention for urine fistula 00- Drain leakage for lymphorrea 7,6%Not applicable- Thrombosis/Embolisms 2,1%1,3%0,74 Bowel lesions (suture) 1,2%0,4%0.65 Overall surgical complications 24%9,1%0,0001 Clavien grade 3-4 surgical complications 4,9%0,4%0,0007 Cardiac/respiratory 3,4%3,5%0,89

43 URINARY CONTINENCE (zero pad) Open (1)Robot (2)P 1° month46.8%64.4 % ° month79.5 %82.7 % ° month87.2 %88.0 % ° month92.3 %94.1 %0.559 Continenza Clinica Urologica, AOUC Careggi

44 Open (1)RALP (2)P NS Bilateral 6 – months potency rate: 38.3% 77.7% 74.3% 79.5% 0.24 NS Monolateral 6 – months potency rate: 29% 43.0% 17.3% 62.5% Non – NS 6 – months potency rate: 32.7% - 8.4% -- Potenza Clinica Urologica, AOUC Careggi

45 UTILIZZO DEL SISTEMA ROBOTICO «MONODISCIPLINARE » ANOMALIA??

46


Download ppt "Donata Villari Sod Urologia II Azienda Ospedaliera Universitaria Careggi Firenze surgery as primary treatment in prostate cancer."

Similar presentations


Ads by Google